發(fā)布時(shí)間：2018-01-08 11:27

  本文關(guān)鍵詞：綜合醫(yī)院手術(shù)室實(shí)習(xí)護(hù)生血源性職業(yè)暴露及標(biāo)準(zhǔn)預(yù)防現(xiàn)狀的調(diào)查研究　出處：《東南大學(xué)》2017年碩士論文　論文類(lèi)型：學(xué)位論文

  更多相關(guān)文章： 手術(shù)室 實(shí)習(xí)護(hù)生 血源性職業(yè)暴露 標(biāo)準(zhǔn)預(yù)防

【摘要】：目的:通過(guò)調(diào)查了解目前綜合醫(yī)院手術(shù)室實(shí)習(xí)護(hù)生血源性職業(yè)暴露的現(xiàn)狀和接受職業(yè)防護(hù)教育的基本情況,了解手術(shù)室實(shí)習(xí)護(hù)生標(biāo)準(zhǔn)預(yù)防知識(shí)掌握情況以及標(biāo)準(zhǔn)預(yù)防執(zhí)行的現(xiàn)狀;分析其主要影響因素,針對(duì)性提出合理化建議,從而提高手術(shù)室實(shí)習(xí)護(hù)生職業(yè)防護(hù)以及標(biāo)準(zhǔn)預(yù)防的認(rèn)知水平,在臨床實(shí)習(xí)前做好各項(xiàng)準(zhǔn)備工作,貫徹執(zhí)行標(biāo)準(zhǔn)預(yù)防的各項(xiàng)措施,最大程度降低血源性職業(yè)暴露風(fēng)險(xiǎn),從而降低院內(nèi)感染發(fā)生率。方法:通過(guò)方便抽樣選擇江蘇省某中醫(yī)院手術(shù)室實(shí)習(xí)護(hù)生230名作為調(diào)查對(duì)象,采用以問(wèn)卷調(diào)查為主,訪談和現(xiàn)場(chǎng)觀察相結(jié)合的調(diào)查方法,應(yīng)用SPSS18.0統(tǒng)計(jì)軟件對(duì)資料進(jìn)行統(tǒng)計(jì)描述和統(tǒng)計(jì)推斷,主要采用構(gòu)成比、卡方檢驗(yàn)、相關(guān)分析、單因素分析以及多因素分析對(duì)結(jié)果進(jìn)行闡述、分析。結(jié)果:本次研究共抽取江蘇省某中醫(yī)院手術(shù)室實(shí)習(xí)護(hù)生230人,發(fā)放230份調(diào)查問(wèn)卷,回收有效問(wèn)卷224份,問(wèn)卷有效率98.67%;手術(shù)室實(shí)習(xí)護(hù)生血源性職業(yè)暴露及標(biāo)準(zhǔn)預(yù)防知識(shí)、執(zhí)行情況調(diào)查問(wèn)卷克隆巴赫系數(shù)為0.91,調(diào)查問(wèn)卷具有良好的信度;內(nèi)容效度指數(shù)I-CVI=1,S-CVI=0.96,調(diào)查問(wèn)卷具有良好的內(nèi)容效度。本次調(diào)查中手術(shù)室實(shí)習(xí)護(hù)生均為本科和專(zhuān)科學(xué)歷,無(wú)中專(zhuān)學(xué)歷,其中本科學(xué)歷占比偏低(20.1%),平均年齡21.2歲,女生占絕大多數(shù)(93.3%)。手術(shù)室實(shí)習(xí)護(hù)生血源性職業(yè)暴露頻繁,大部分護(hù)生實(shí)習(xí)期間接觸過(guò)乙肝、艾滋病等血源性傳播疾病患者。將本次調(diào)查中手術(shù)室實(shí)習(xí)護(hù)生接觸乙肝病毒攜帶者和艾滋病毒攜帶者的情況進(jìn)行卡方檢驗(yàn),χ2為10.61,P小于0.05,差異有統(tǒng)計(jì)學(xué)意義。手術(shù)室實(shí)習(xí)護(hù)生血源性職業(yè)暴露的主要威脅來(lái)源于乙型肝炎病毒,但是僅有70.1%的實(shí)習(xí)護(hù)生注射過(guò)乙肝疫苗,39.7%的實(shí)習(xí)護(hù)生乙肝抗體為陽(yáng)性。實(shí)習(xí)護(hù)生實(shí)習(xí)期間針刺傷發(fā)生率很高,95.1%的護(hù)生實(shí)習(xí)期間發(fā)生過(guò)針刺傷,發(fā)生針刺傷時(shí)大部分實(shí)習(xí)護(hù)生處于搶救病人的工作狀態(tài),其次是工作比較繁忙時(shí),發(fā)生針刺傷后,99%的護(hù)生都及時(shí)進(jìn)行了必要的處理,但每次都匯報(bào)的比例不高,僅占17%。不匯報(bào)的原因大部分是認(rèn)為輕微不足以匯報(bào),其次是不知道向誰(shuí)匯報(bào)。大部分手術(shù)室實(shí)習(xí)護(hù)生接受過(guò)標(biāo)準(zhǔn)預(yù)防教育,但接受標(biāo)準(zhǔn)預(yù)防教育的次數(shù)少,平均1-2次。接受標(biāo)準(zhǔn)預(yù)防教育的途徑主要是傳統(tǒng)途徑,96.9%的實(shí)習(xí)護(hù)生認(rèn)為需要繼續(xù)接受標(biāo)準(zhǔn)預(yù)防和職業(yè)防護(hù)的相關(guān)培訓(xùn)。標(biāo)準(zhǔn)預(yù)防相關(guān)知識(shí)缺乏,尤其是手術(shù)室相關(guān)專(zhuān)科知識(shí)缺乏,本科學(xué)歷的手術(shù)室實(shí)習(xí)護(hù)生標(biāo)準(zhǔn)預(yù)防知識(shí)掌握情況優(yōu)于專(zhuān)科學(xué)歷的手術(shù)室實(shí)習(xí)護(hù)生。職業(yè)防護(hù)用具使用率低,護(hù)目鏡的的使用率僅為21%,隔離衣使用率僅為18%,影響實(shí)習(xí)護(hù)生戴護(hù)目鏡、穿隔離衣的主要原因是不易獲得。手套使用不規(guī)范,影響實(shí)習(xí)護(hù)生戴手套的主要原因是戴手套手感不好,影響操作。大部分手術(shù)室實(shí)習(xí)護(hù)生注射器、手術(shù)刀片等銳器處理較為規(guī)范,醫(yī)療垃圾的分類(lèi)較為理想,但是手術(shù)刀、縫針的傳遞規(guī)范化程度較低,接觸血液傳播疾病患者時(shí)戴雙層手套情況差,連臺(tái)手術(shù)手術(shù)間清潔不徹底,一人一床單被套執(zhí)行不到位。與手術(shù)室專(zhuān)科性強(qiáng),實(shí)習(xí)護(hù)生專(zhuān)科理論知識(shí)缺乏以及專(zhuān)科操作不熟練有關(guān)。結(jié)論:手術(shù)室實(shí)習(xí)護(hù)生血源性職業(yè)暴露嚴(yán)重,主要面臨乙型肝炎病毒的威脅,職業(yè)防護(hù)不到位。衛(wèi)生行政主管部門(mén)應(yīng)規(guī)范各級(jí)醫(yī)院的職業(yè)防護(hù)用品配備,確保各類(lèi)人員獲得必需的職業(yè)防護(hù)用品。實(shí)習(xí)護(hù)生普遍自我防護(hù)意識(shí)差,對(duì)自身乙肝抗體情況不了解,未能全部進(jìn)行疫苗接種或補(bǔ)種。因此學(xué)校在臨床實(shí)習(xí)前動(dòng)員實(shí)習(xí)護(hù)生檢測(cè)乙肝抗體情況并注射乙肝疫苗。大部分實(shí)習(xí)護(hù)生進(jìn)行臨床實(shí)習(xí)前接受了標(biāo)準(zhǔn)預(yù)防和職業(yè)防護(hù)教育,但次數(shù)少,專(zhuān)科針對(duì)性差。接受標(biāo)準(zhǔn)預(yù)防教育和職業(yè)防護(hù)的途徑以傳統(tǒng)途徑為主。醫(yī)學(xué)院�？梢钥紤]增加標(biāo)準(zhǔn)預(yù)防和職業(yè)防護(hù)教育的課時(shí)數(shù),豐富教學(xué)形式。標(biāo)準(zhǔn)預(yù)防相關(guān)知識(shí)缺乏,尤其是手術(shù)室專(zhuān)科防護(hù)知識(shí)缺乏,需要進(jìn)行系統(tǒng)的專(zhuān)科職業(yè)防護(hù)教育。手術(shù)室?guī)Ы汤蠋熆舍槍?duì)手術(shù)室特點(diǎn)采用多種教學(xué)形式向?qū)嵙?xí)護(hù)生講解面臨的職業(yè)暴露風(fēng)險(xiǎn)以及防護(hù)對(duì)策。標(biāo)準(zhǔn)預(yù)防執(zhí)行情況不容樂(lè)觀。尤其是手術(shù)室專(zhuān)科標(biāo)準(zhǔn)預(yù)防執(zhí)行情況令人堪憂(yōu)。建議規(guī)范操作流程并推廣使用安全型耗材。
[Abstract]:Objective: To investigate the current status of general hospital operation room practice hematogenous occupation exposure and the basic acceptance of occupation protection education for nursing students, nursing students in the operation room to understand and master the current status of standard prevention knowledge of standard prevention; analysis of the main influencing factors, puts forward reasonable suggestions, so as to improve the cognitive level of nursing practice in operation room health protection and prevention of occupation standard, do the preparatory work in clinical practice, the implementation of the measures of prevention standards, to minimize the risk of blood borne occupation exposure, so as to reduce the incidence of nosocomial infection. Methods: by convenience sampling in Jiangsu Province in a hospital operation room nursing students of 230 as the research object, using the based on a questionnaire survey method, interviews and field observation combined with the application of statistical software SPSS18.0 for statistical data Description and statistical inference, mainly by constituent ratio, chi square test, correlation analysis, single factor analysis and multi factor analysis of the results described and analyzed. Results: the study from Jiangsu Provincial Hospital of traditional Chinese medicine operation room, 230 nursing students, issued 230 questionnaires, 224 valid questionnaires, questionnaire the efficiency of the 98.67% nursing students in the operation room; hematogenous occupation exposure and standard prevention knowledge, the implementation of the questionnaire clone of Bach coefficient is 0.91, the questionnaire has good reliability; the content validity index of I-CVI=1 and S-CVI=0.96, the questionnaire has good content validity. Operation room the survey of nursing students for undergraduate and college education, no secondary education, undergraduate education accounted for the low (20.1%), the average age is 21.2 years old, girls are in the majority (93.3%). Nursing students in the operation room of hematogenous occupation exposed frequently, most of nursing students in internship The contact between the hepatitis B patients, AIDS and other blood borne diseases. The operation room in this investigation practice exposure to hepatitis B virus carriers and HIV carriers in nursing students of the chi square test, 2 x 10.61, P less than 0.05, the difference was statistically significant. Nursing students in the operation room the main sources of threat exposure to blood borne hepatitis occupation hepatitis B virus, but only 70.1% of the injected hepatitis B vaccine internship nursing students, 39.7% nursing students of hepatitis B antibody was positive. Nursing students during the period of high incidence of needlestick injuries among nursing students during the internship, 95.1% had needle needle stabbed when most of nursing students in rescuing patients working state, then work is busy, the needle stabbed, 99% nursing students were carried out in a timely manner the necessary treatment, but each reporting ratio is not high, only accounted for a large part of 17%. does not report is recognized For the slight to report, then do not know who to report to. Most of nursing students in the operation room received the standard preventive education, but the number of accepted standard prevention education, the average 1-2 times. Way of accepting standard prevention education is mainly traditional way, 96.9% internship training that continue to accept the standard prevention and protection for occupation the standard of nursing students. Prevention of lack of knowledge, especially the lack of knowledge related to operation room specialist, undergraduate nursing students in the operation room of standard prevention knowledge is better than college degree nursing students in the operation room. Occupational protective equipment utilization rate is low, the use of goggles the rate was only 21%, the usage rate of scrubs is only 18%. Wear goggles to student nurses' practice, the main reason is not easy to wear gowns. Gloves are not standardized, the main reason of nursing students wearing gloves is wearing gloves hand feeling not good practice effect, Effect of injector operation. Most of nursing students in operation room surgery practice, sharp blade processing is standard, classification of medical waste is ideal, but the scalpel, needle transfer standardization degree is low, wearing double gloves of blood transmitted diseases in patients with poor contact, even surgery operating room cleaning is not thorough, a bedspread the implementation is not in place. And the operation room specialized nursing students, lack of specialized knowledge and the specialized operation is not skilled. Conclusion: nursing students in the operation room of hematogenous occupation exposure is serious, the main face of hepatitis B virus threats, occupation protection is not in place. The health administrative departments at all levels should occupation protection standard hospital equipped to ensure all kinds of personnel to obtain occupation protective equipment required. Students generally poor awareness of self protection practice, lack of understanding of their own cases of hepatitis B antibody, not all disease Inoculation or replant. So the school in the clinical practice of detection of hepatitis B antibody and mobilization of hepatitis B vaccine for nursing students. Most of nursing students before clinical practice accepted standard prevention and occupation protection education, but fewer college targeted poor. Accept the standard way of prevention education and occupation protection in the traditional way.. medical colleges can consider increasing the number of hours in the standard prevention and occupation protection education, enrich the teaching forms. The standard prevention of lack of knowledge, especially the lack of knowledge of specialized in operation room door, the need for specialized vocational protection education system. Teachers can according to the operation room operation room features using a variety of teaching forms to the nursing students on the face occupation exposure and protection countermeasures. Standard prevention situation is not optimistic. Especially the implementation of worrying prevention operation room specialist standard. It is recommended to standardize the operation process and promote the use of safe consumables.

【學(xué)位授予單位】：東南大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R47

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